TY - JOUR
T1 - Bipolarity in Older individuals Living without Drugs (BOLD)
T2 - Protocol and preliminary findings
AU - Beunders, Alexandra J M
AU - Regeer, Eline
AU - van Eijkelen, Marieke
AU - Mathijssen, Henk
AU - Nijboer, Chris
AU - Schouws, Sigfried N T M
AU - van Oppen, Patricia
AU - Kok, Almar A L
AU - Kupka, Ralph W
AU - Dols, Annemiek
N1 - Funding Information: The authors thank Tokie Kemp (TK), Azita Ghasemi and Marrit Schouten for their assistance with the data collection. This study was funded by VCVGZ Stichting tot Steun, project number 276. This funding source had no role in the design of this study, its execution, analyses, interpretation of the data, or decision to submit results. Publisher Copyright: © 2023 The Authors
PY - 2024/3/1
Y1 - 2024/3/1
N2 - INTRODUCTION: Although clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment.METHODS: The mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed.RESULTS: BD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning.LIMITATIONS: Our findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias.CONCLUSION: A group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).
AB - INTRODUCTION: Although clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment.METHODS: The mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed.RESULTS: BD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning.LIMITATIONS: Our findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias.CONCLUSION: A group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).
KW - Bipolar
KW - Functioning
KW - Medication
KW - Naturalistic course
UR - http://www.scopus.com/inward/record.url?scp=85181258691&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jad.2023.12.047
DO - https://doi.org/10.1016/j.jad.2023.12.047
M3 - Article
C2 - 38154581
SN - 0165-0327
VL - 348
SP - 160
EP - 166
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -